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Expensive lunch

BMJ 2005; 331 doi: (Published 01 September 2005) Cite this as: BMJ 2005;331:0509344
  1. Michael J Westerhaus, fourth year medical student and masters student in medical anthropology1
  1. 1Harvard Medical School and Harvard Graduate School of Arts and Sciences

Michael Westerhaus looks at the implications of free lunches and pharmaceutical gifting of healthcare professionals

As a young child, I remember my fascination with the endless offers for free items on breakfast cereal boxes. The word “free” hypnotised me. My mum, however, knew that free meant someone, somewhere, would pay for it. Thus, one of her favourite mantras was, “Nothing's free.”

Close encounters

My mum's words haunted me just months ago in the most unlikely of places—an HIV clinic in an urban US setting, where I was rotating as a medical student. During the morning of my first day in the clinic, I listened to the stories of patients presenting for HIV check-ups. Many of the patients shared chronicles of struggling to survive on incomes below the poverty line, working long hours for a meager income, and labouring to maintain adequate housing and nutrition.

Humbled by the morning narratives of struggle and suffering recounted by patients, I was unprepared for the shock awaiting me at lunchtime that day. Entering the clinic's conference room to join the staff of physicians, nurses, pharmacists, social workers, and HIV prevention specialists, I was faced with the aroma and sight of an extravagant Olive Garden lunch, including chicken parmesan, Caesar salad, spaghetti and meatballs, and a tray of rich tiramisu. All the food had been provided by a pharmaceutical representative, who was present to answer questions about her company's latest HIV drug. Reproach for the episode unfolding before me didn't, however, prevent me from filling a plate.

As I shamefully seated myself with a full plate of food in hand, a clinic staff member leaned over and whispered that “free lunch” was provided every day of the week except Tuesday. As the pharmaceutical representative extolled the virtues of her company's products, guilt swallowed me with every bite …

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